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Transplant Network Undercaptures Post-Transplant Skin Cancers

Thuzar M.Shin MD, PhD
Assistant Professor of Dermatology
Hospital of the University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Organ Procurement Transplant Network (OPTN) collects data on cancers that develop after organ transplantation. Previous studies have shown incomplete reporting to the OPTN for many cancers (including melanoma). Skin cancer is the most common malignancy in solid organ transplant recipients and the most common post-transplant skin cancer, cutaneous squamous cell carcinoma (cSCC), is not captured in standard cancer registries. We hypothesized that cSCC and melanoma are underreported to the OPTN. When compared to detailed medical record review obtained from the Transplant Skin Cancer Network database (JAMA Dermatol. 2017 Mar 1;153(3):296-303), we found that the sensitivity of reporting to the OPTN was only 41% for cSCC and 22% for melanoma. The specificity (99% for cSCC and 100% for melanoma) and negative predictive values (93% for cSCC and 99% for melanoma) were high. As a result, the OPTN database is unable to robustly and reliably distinguish between organ transplant recipients with and without these two skin malignancies.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: We hope readers will be aware that the OPTN database significantly undercaptures post-transplant cSCC and melanoma, which in turn underestimates the magnitude of these adverse events. Dermatologists can improve the validity of OPTN data by communicating all post-transplant skin cancers to the transplant team, and educating patients about their post-transplant skin malignancies – specifically the type (cSCC, melanoma, etc.) – in the hopes of increasing self-reporting accuracy. Transplants teams can also enhance skin cancer reporting to the OPTN by eliciting a skin cancer history at each follow up visit, and verifying patient self-report of a skin cancer with a pathology report or clinical documentation from the treating physician. Our hope is that improved communication and reporting will increase the completeness and accuracy of this database, which is critical for understanding the epidemiology of skin cancers in organ transplant recipients and may inform future interventions to reduce morbidity in this population.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Areas of future research that were brought to light as a result of our findings include:
1) investigation of variables that were not part of our current study that may affect reporting of skin cancers to the OPTN database (such as administrative support, access to dermatology records, and other barriers to reporting),
2) the quality of post-transplant malignancy reporting for other types of cancers, including other skin cancers, and
3) measures that improve reporting of post-transplant cancers to the OPTN.

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